Schizophrenia Spectrum and Other Psychotic Disorders, Social Interaction
Conditions
Brief summary
Social functioning deficits are among the most disabling and difficult to treat aspects of schizophrenia. An essential component of social functioning is metacognition-a process that is profoundly disrupted in schizophrenia and represents the ability to reflect upon the mental states of oneself and others. To date, treatment efforts in schizophrenia have been hindered by barriers in accurately monitoring client's real-world social interactions. Recently, wearable technologies have evolved to provide therapists with innovative, ecologically-valid tools. The Electronically Activated Recorder is a wearable audio recorder that collects behavioral samples at pre-programmed intervals; it holds great promise as a method for yielding concrete, real-world examples of social interactions that can be used by therapists in session to enhance metacognition. Despite the immense costs of social functioning deficits, no previous studies have investigated whether functioning can be improved by integrating wearable audio recorders with psychosocial interventions. By enhancing therapy using a wearable recording device, this proposal's primary goal is to implement a novel intervention that targets metacognitive deficits to improve social functioning. The novel intervention will be tailored to individual clients-based on the content of recorded social interactions-in a way that is not possible using traditional psychotherapy. This will allow clients and therapists to step out of the therapy room by offering a window into how clients process material in real-world interactions. In this study, a randomized controlled trial will be conducted with two schizophrenia groups receiving six months of individualized: 1) Metacognition Reflection and Insight Therapy (MERIT) alone (Standard MERIT); and 2) Tailored MERIT using wearable audio recorders. In this study, our specific aims will test feasibility, effectiveness, and acceptability of Tailored MERIT.
Interventions
BEHAVIORALTailored MERIT
see arm description
BEHAVIORALStandard MERIT
see arm description
Sponsors
Indiana University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Positive screen for metacognitive dysfunction * Serious Mental Illness diagnosis (schizophrenia-spectrum) * Age 18-60 * English fluency * Currently in non-acute phase of illness
Exclusion criteria
* Inability to provide informed consent * Current substance dependence * Documented intellectual disability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| EAR Experiential Questionnaire | Average of EAR acceptability from baseline and 6 month assessment sessions | Assessment of how acceptable wearing the EAR was and how typical days were that EAR was worn. Scores for each item range from 1 to 5 with greater scores indicating greater problems (and lower acceptability). |
| Global Functioning Scale: Social (GFS) | Change from baseline social functioning to social functioning after 6 months of MERIT | 10-point measure of social functioning (1 to 10, with increasing scores indicating greater social functioning) |
| Metacognitive Beliefs Questionnaire-Brief (MCQ-30) | Change from baseline metacognition to metacognition after 6 months of MERIT | 30 item measure of metacognition; each item is rated on a 1 to 4 scale with decreasing scores representing better metacognitive functioning. |
| The Positive and Negative Syndrome Scale (PANSS) | Change from baseline symptoms to symptoms after 6 months of MERIT | 30 item measure of symptoms; each item is rated 1 to 7, with greater scores representing more severe symptoms (and lower scores indicating better functioning) |
| EAR Adherence | Average of EAR adherence from baseline and 6 month assessment sessions | Objective measure of how often EAR was worn; 0 (not worn) and 1 (worn) scores given at each of 48 potential time points. Total score represents frequency that the EAR is worn across all time points. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of Life Scale | Change from baseline quality of life to quality of life after 6 months of MERIT | 21 item measure of quality of life; each item is rated from 0 to 6, with greater scores indicating greater quality of life. |
| Metacognition Assessment Scale- Abbreviated (MAS-A) | Change from baseline metacognitive capacity to metacognitive capacity after 6 months of MERIT | Clinician-rated measure of metacognition using a semi structured clinical interview; four areas of capacity are rated (0 to 28 on overall scale); for each, increasing scores represent greater capacity. |
| Short Form Health Survey (SF-36 | Change from baseline functioning to functioning after 6 months of MERIT | 36 item measure of social functioning and general health behaviors; each item on a different scale but greater scores indicate better overall functioning. |
| Objective Behaviors from the Electronically Activated Recorder | Baseline, 3 months into MERIT, 6 months into MERIT (MERIT completed) | EAR coding can be implemented to rate different forms of objective behaviors; codes generated using different scales but primarily use a 0 (not present) or 1 (present) coding scheme. Greater scores typically represent presence of that which is being coded. |
| Scale to Assess Unawareness of Mental Disorder | Baseline, 3 months into MERIT, 6 months into MERIT (MERIT completed) | Insight measure; three items rated on 1 to 5 scale, with increasing scores indicating poorer insight. |
Outcome results
None listed